Hypofractionated External-Beam Radiotherapy for Prostate Cancer

Abstract

There are radiobiological rationales supporting hypofractionated radiotherapy for prostate cancer. The recent advancements in treatment planning and delivery allow sophisticated radiation treatments to take advantage of the differences in radiobiology of prostate cancer and the surrounding normal tissues. The preliminary results from clinical studies indicate that abbreviated fractionation programs can result in successful treatment of localized prostate cancer without escalation of late toxicity.

Patient-reported quality of life after stereotactic body radiotherapy (SBRT), intensity modulated radiotherapy (IMRT), and brachytherapy

“…SBRT represents a newly-developed technique that is convenient for patients, less expensive, and appears to be efficacious in institutional trials [30]. However, concerns have been raised about increased toxicity after SBRT [9,10], and it was recently reiterated that it is not acceptable to burden patients with a trade-off between the convenience of SBRT and potentially increased toxicity [10].…”

Stereotactic Body Radiation Therapy Versus Intensity-Modulated Radiation Therapy for Prostate Cancer: Less Cost at the Expense of More Genitourinary Toxicity Is a Concerning But Testable Hypothesis

“…The unfortunate result of these claims regarding screening for and treatment of PC is that some men facing a diagnosis of PC are requesting de-escalation of, or no immediate treatment for, their PC in an effort to avoid the possibility of experiencing toxicity without clinical benefit or overtreatment. To that end, treatments such as focal ablation 13 and shortened (or accelerated) courses of radiation therapy using cyberknife or stereotactic body radiation therapy (SBRT) 14 are being studied, however randomized evidence of comparable toxicity and efficacy compared with accepted standard of practice are currently unavailable. Of concern, while only a theoretical basis for improved local control with accelerated radiation treatment exists, 15 this approach is being used to treat men with PC off study.…”

Hypofractionated Radiotherapy in Low Risk Prostate Cancer: Preliminary Experience

“…Other studies have determined a general biochemical control rate of 83% at 5 years. Our patients, with one year follow up, are low PSA levels, none has achieved an increase that meets the established class definition for biochemical failure in Phoenix; to date our control is 100%, considering it is a study program at a single institution hypofractionation reporting preliminary results [13][14][15][16][17][18][19].…”